Utah is in the middle of one of the largest measles outbreaks documented in the United States this year, with 102 confirmed cases as of Nov. 25. State health officials have identified a steady rise, including 24 cases in the last three weeks of available reporting. With vaccination gaps, new school based clusters, and ongoing mistrust of the medical system, the state is preparing for the outbreak to expand rather than diminish.
Utah State Epidemiologist Leisha Nolen described the situation plainly. “I think we actually have more to come before it gets better,” she told Utah News Dispatch. Her warning reflects the concern that the virus has spread beyond its initial concentration and is entering communities that are less protected due to long standing skepticism about vaccines and government institutions.
The United States is experiencing its highest measles caseload in more than two decades and is positioned to lose its elimination status for the first time in over twenty years. By late November, federal health officials had confirmed 1,798 measles cases across 43 jurisdictions. Of those cases, 12 percent or 212 people have been hospitalized, and three people have died. Texas remains the hardest hit, with more than 800 confirmed cases according to the U.S. Centers for Disease Control and Prevention. Utah and Arizona are among the states with the most recent spikes.
Utah’s outbreak has not resulted in any confirmed deaths. Eleven people have been hospitalized, and Nolen reported encouraging outcomes so far. “Happily,” she said, “they’ve all been fairly minor and been able to be discharged fairly rapidly.” Still, she urged residents to take the virus seriously because unvaccinated children and those who are too young to be vaccinated face the highest risk of severe illness.
Washington County in southwest Utah has recorded 74 cases and remains the center of the state’s outbreak. But the virus has now spread north into Wasatch County, where a cluster of infections has emerged inside a local high school. At least eight Wasatch High School students have been confirmed infected. Nolen described the development with concern. The outbreak at Wasatch High School “really worries me.” She added, “That is a new area to be infected. And it’s quite concerning that we suddenly saw so many people with this infection in one school.”
Wasatch County has some of the lowest public school measles vaccination rates in Utah. “So we know that area is vulnerable to a continued spread of measles now that it’s introduced,” Nolen said. She explained why schools can become accelerators of community wide outbreaks. “It’s one thing to have it localized in one school, but we know those kids go home, they have siblings at home, and they go do things that expose others. So I am worried that we’re going to have expansion from that in the immediate future.”
The timing of symptoms earlier in the month also contributed to spread. “There were a few days nobody realized it was even measles, (and) they were probably going around while they were infectious,” Nolen said.
Public health experts are focusing on several factors that are driving outbreaks across Utah and the country. These include low vaccination rates, skepticism that grew during the COVID 19 pandemic, and widespread distrust of medical institutions. Nolen described this combination directly. “There’s a lot of misinformation and distrust fueling people’s behaviors and how they make choices, and that is making the outbreak worse,” she said.
Although the public often compares today’s vaccine debates to the experience of the COVID 19 pandemic, Nolen emphasized a key distinction. The measles outbreak is “not at all like COVID” because “an effective vaccine has existed for decades and the virus was largely stamped out before vaccination rates began dropping.”
Today, most people remain protected. But as more parents opt out of vaccinating their children, the risk of uncontrolled spread grows. Nolen described the complexity behind declining vaccination rates. “I certainly think there’s a lot of factors contributing to why people don’t get vaccinations. Part of it is they don’t know who to trust,” she said. She added, “Certainly these days there’s so many conflicting voices … I understand why they don’t know who to believe. The internet has allowed it so that many voices are very loud, and it’s hard if you aren’t familiar with science or how different systems work to know who to trust.”
In Utah and elsewhere, religious and cultural dynamics are also contributing to the spread. The New York Times previously reported that the West Texas outbreak spread mainly through a large Mennonite community. In Utah, Washington County’s outbreak includes cases linked to Short Creek, a region with a history of polygamy and past ties to the Fundamentalist Church of Jesus Christ of Latter day Saints. Although the area is now described as increasingly ex FLDS, the Tucson Sentinel reported that vaccination rates remain too low to stop measles transmission.
Nolen explained that distrust in both government and medical systems shapes decision making in these communities. “One of the things we’re trying to do is increase communications with these communities so that we know what they are concerned about and so that we can work with them to help improve their health and make them understand what’s the best way they can do it for themselves,” she said.
That distrust also affects measles surveillance. Some community members avoid medical care entirely, meaning official case numbers likely under count the true spread of the virus. Salt Lake County identified what was likely its first measles case but labeled it “probable” because the patient refused to be tested and did not cooperate with public health investigators.
Nolen said, “It’s going to be different in different communities, but I think there are communities that have not just a distrust in government, but they have a distrust of medical systems. And so those people are going to be much less likely to come forward, and so we won’t be able to know how many people are sick in those areas.” In contrast, she noted that other parts of Utah, “they might not love the government, but they still are very accepting of health care, and so they will go forward to their health care providers, and that will help us give a better idea of those areas.”
The result is incomplete data. According to Nolen, Utah officials will have a “slightly skewed understanding” of the true extent of measles across the state. She said, “We have heard from many community members that they know that there are individuals in their community who have symptoms—even the patients believe they have measles, but they don’t go in and get tested.” Nolen added, “So we know there are a number of people who just stay home and suffer through this illness without getting any medical attention. We can’t count those people, so we don’t know how many exist, but we certainly hear from community members that that is happening.”
Nolen also expressed concern for children and others who face the consequences of decisions made by adults. She worried for “kids who don’t have a choice, their parents have chosen whether or not to vaccinate.” She also worried about “people who unfortunately have gotten misinformation and therefore aren’t choosing to protect their families.”
Measles can cause severe complications in unvaccinated individuals. Symptoms generally begin seven to fourteen days after infection and include fever, cough, runny nose, and red or watery eyes. Tiny white spots typically appear inside the mouth two to three days after symptoms begin. Three to five days after the first symptoms, a rash emerges. The rash usually appears as flat red spots at the hairline or on the face and then spreads down the body. While some will have mild illness, “about 1 in 5 unvaccinated people need to be hospitalized,” according to health officials. Young children, pregnant women, and people with weakened immune systems face the highest risk.
As Utah officials prepare for additional cases, the outbreak highlights the consequences of declining vaccination rates, the spread of misinformation, and persistent distrust in public health systems. The full scope of the outbreak remains uncertain, but the risks facing vulnerable communities are already clear.
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